Functional outcomes of repeat kidney resection in patients with cancer recurrence after nephron-sparing surgeries

Abstract

Aim. To perform comparative analysis of functional outcomes of repeat kidney resection and radical nephrectomy in patients with local cancer recurrence after previous organ-sparing surgeries.Materials and methods. Data on 64 patients who underwent surgical treatment at the Oncourology Department of the N.N. Blokhin National Medical Research Center of Oncology between 2000 and 2022 due to local kidney cancer recurrence after previous nephron-sparing surgeries were retrospectively and prospectively included in the study. Among these, 37 (57.8 %) patients underwent repeat kidney resection (treatment group) and 27 (42.2 %) patients underwent radical nephrectomy (control group). The groups were matched in demographic and clinical characteristics (р >0.05). Median diameter of recurrent tumor in the treatment and control groups was 2.5 and 3.0 cm, respectively (95 % confidence interval 2.0–3.0 cm; Q1–Q3 2.4–4.0 cm). This difference was statistically significant (р = 0.012), but not clinically. Median follow-up duration was 35 (3–131) months (Q1–Q3 13–57 months).Results. Repeat nephron-sparing surgeries correlated with lower decrease in kidney function compared to organ-resecting surgical treatment. In the early postoperative period, decrease in calculated glomerular filtration rate per the CKD-EPI formula compared to baseline after re-resection and nephrectomy was 16 and 32 % (р = 0.010); long-term, it was 8 ± 41 and 45 ± 22 % (р <0.001), respectively. Complication rates in the groups were similar: 21.6 and 29.6 %, respectively (р = 0.563).Conclusion. For local kidney cancer recurrence, repeat resection promotes preservation of kidney function without increased complication rate.